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l <br /> Wisconsin Depamient of Commerce SOIL EVALUATION REPORTry <br /> Division of Safety and Buildings Page/of <br /> � In accordancevritir.Cormn 85,Will. Adm. Cade <br /> Attach complete site plan on paper not less than 8 1!2 x 11 inches in size.Plan must County 8 k r n e 77' <br /> I Include,but rpt limited to:vertical and horizontal reference point(BM),direction and <br /> Percent slope,scab or dimensions,north arrow,and location and distance to nearest road. Parcel I.D. <br /> do - 9/N.S- 0,(000 <br /> Please Print ail information. Rev awed by Date <br /> A 09 <br /> Personal information you Provide MY be used for secondary purposes(p j.W Lew,S.15.01(1)(m)). <br /> yProperty Owner Property Location <br /> 27/Ll <br /> /✓)ark OµeIle VC Govt.Lot 1/4 1/4 S /8 T qD N R /6 E(or)6 <br /> E Properly Owner's Mailing Address Lot# Bbak# Sift.Name or CSW <br /> 7//o wesf //3fh SfreeF /O <br /> -?nod( r6r0. 4 PvrlansF'ocrCneS <br /> CflY State Zip Code Phone Number ❑sty ❑Villa e <br /> /.3/oo»irn )yr *1N .SS438 9 ® d <br /> Town . Nearest Road �87� <br /> ( ) mak a.n E• it//ewR..a,- led.® New Construction Use:® Residential!Number of bedrooms•�_ Code derived design flow rate /SO <br /> [3 Replacement GPD <br /> ❑ Public o commercial-Describe: <br /> Parent material G/ac/a/ .(7 Fr Flood Plain elevation if applicable N/A <br /> General comments ft <br /> and recommendations: 3y s. a(e✓. ` C 93.IR 40 <br /> A8104C dS 3956 - h dfmi Sno( <br /> Boring# [) Boring <br /> ® Pit Ground surface elev. qb. .� ft. Depth to smiting factor > JV A in. <br /> Horizon Depth Dorrdnant Calm Redox Desai Shc 'cation Rate <br /> Description Texture Sfnrcttrre Consistence Boundary Roots GPDAF <br /> in. Munsell Ou.Sz. Cont Color Gr.Sz.Sh. <br /> / o- 'EfF#1 'Eft#2 <br /> !3 /pneb/c wr! cs 3m . 7 1. 4 <br /> /S d..rSbk ,n / G s <br /> 7 /• 6 <br /> 4 yd-8d 7.s YR s/v S oSG <br /> Boring# Bonng <br /> Pit Ground surface elev. 95.c/ ft. Depth to ilmitirg factor -2 7-' in. <br /> Horizon Depth DominantColo Redox Desai Soil Rate <br /> lotion Texture Strucbue Consistence Boundary Roots GPDAF <br /> in. Munsell Ou.Sz Cont.Color Gr.Sz.Sh. <br /> o— y 7•SYR'./A 'E1f#1 'Eff#2 <br /> /1 <br /> 3v l G1 3cm 7 <br /> dY• fb 7.3 YR �G <br /> . 7 <br /> Effluent#1 =BOD >30<220 mq&and TSS>30<150 mg& 'Effluent#2=BOD <30 <br /> (ST Name(Please Print) Signature — 1L and TSS 130 mWL <br /> Ch1 Bs 5 �nre�S S /1 CST Number <br /> address l/ tTelophne <br /> Date Evaluation Connducted oNumber <br /> 14Jrbs1(-- wrS�r8sd3- 0 9lis= 4/ _7 <br />